=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881057404
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN SMITH MA PD LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2016
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 KINDERKAMACK RD STE 201S
-----------------------------------------------------
City | ORADELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07649-1591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-266-0668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 KINDERKAMACK RD STE 201S
-----------------------------------------------------
City | ORADELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07649-1591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-266-0668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 37FI00176001
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------